MEDICARE: FS LEISURE PARK TENANT TRUST

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	310400000X	Assisted Living Facility

General Provider Information

NPI Number	:	1447634266
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FS LEISURE PARK TENANT TRUST

Provider Business Mailing Address
First Line	:	1400 ROUTE 70
Second Line	:
City	:	LAKEWOOD
State	:	NJ
Zip	:	08701-5949
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1400 ROUTE 70
Second Line	:
City	:	LAKEWOOD
State	:	NJ
Zip	:	08701-5949
Country	:	US
Telephone Number	:	732-370-0444
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT & CHIEF EXECUTIVE OFFICER
Name	:	KATHERINE E POTTER
Credential	:
Telephone Number	:	617-796-8387

Provider Enumeration Date	:	07/10/2015
Last Update Date	:	03/26/2019

Similar Medicare Providers

1861560187 — FS LEISURE PARK TENANT TRUST
Practice Location Address:

1400 HIGHWAY 70
LAKEWOOD, NJ
08701-5949

Practice Phone: 732-370-0444
Practice Fax: 732-370-1783

1467674051 — MRS. CHRISTINE R AYLETT PT
Practice Location Address:

1400 HIGHWAY 70
LAKEWOOD, NJ
08701-5949

Practice Phone: 732-370-0444
Practice Fax:

1871005348 — ELIZABETH CONNELLY BROWN
Practice Location Address:

1400 ROUTE 70
LAKEWOOD, NJ
08701-5949

Practice Phone: 732-674-5825
Practice Fax:

1376190660 — SNH NJ TENANT LLC
Practice Location Address:

1400 ROUTE 70
LAKEWOOD, NJ
08701-5949

Practice Phone: 732-370-0444
Practice Fax: 732-370-1783

1407404015 — SNH NJ TENANT LLC
Practice Location Address:

1400 ROUTE 70
LAKEWOOD, NJ
08701-5949

Practice Phone: 732-370-0444
Practice Fax: 732-370-1783

1346833456 — MRS. JAMIE MARIE GUADAGNINO MA SLP
Practice Location Address:

1400 ROUTE 70
LAKEWOOD, NJ
08701-5949

Practice Phone: 732-370-0444
Practice Fax:

Directions to “FS LEISURE PARK TENANT TRUST ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.